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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3650
Location 0039 SAGINAW STREET Contrae::tvr°°A'fi'ROL➢L'S INC.
Address P O '&OX 71
Type Work DRIVEWAY
$OUT�I WINDSOR"CT 06074
Phone:;NcS (80) 401,;''
Date Insp Needed
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Time Insp Needed
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Inspected By
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Work in Progress
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Input ( Drxte
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Permit No. 3650 Town of South Windsor, CT
Date 03/23/2004 Street Excavation Permit
Expiration Date 03/23/2005
Descrip:
Applicant Location
Name AIROLDI'S INC. 0039.. SAGINAW .$TRikT
Addr. P O BOX 71
SOUTH WINDSOR CT 4.5b7.4 Trpe of Wei'rk AR±WwAl:
Phone (860) 896-0401
F.
Applicant agrees to ftirn�sli the Tovp ref 5ot'h Windor the;,,amount of bond
ij
required and to reiMbtzrse:'the Iown gf!StSuth1ridsor for' any :'expenses
incurred by the Towj fof, ma".X: t nonce""or repair 'work in Conn:gc,tion with this
permit and that appl .cant is fami' J.a it h .aid 'wiYl 'de .by t e rules and
regulations for permiG.s a outlined adshSou 'ht :ad�or's Street
Cut Permit Manual.
* * PERMIT TO BE KEPT ON`''JOB Sh E AT :ALL. TT'NJES.
Issued b ------
Y �i_--- _ Title
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Date Completed -- ------ Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT ( 50
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.—
Ad d ress of Firm 1
Location of proposed work ,," " — •+
Describe fully nature of permit requested
Starting date —\—o Approx.time for completion- �—
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
the Police Dept. and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:�, ��\ Date• \
Title
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc